Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $46.14 / $62.44 / $91.83	Facility	26	$46.14	$62.44	$91.83
Aetna Facility/Professional Professional Modifier Low / Median / High Price $166.22 / $302.93 / $613.74	Professional		$166.22	$302.93	$613.74
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $47.85 / $68.64 / $183.50	Professional	26	$47.85	$68.64	$183.50
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $120.07 / $216.93 / $494.57	Professional	TC	$120.07	$216.93	$494.57
CareFirst Facility/Professional Professional Modifier Low / Median / High Price $258.56 / $280.07 / $361.40	Professional		$258.56	$280.07	$361.40
CareFirst Facility/Professional Professional Modifier 26 Low / Median / High Price $65.42 / $72.68 / $102.65	Professional	26	$65.42	$72.68	$102.65
CareFirst Facility/Professional Professional Modifier TC Low / Median / High Price $189.01 / $207.38 / $274.36	Professional	TC	$189.01	$207.38	$274.36
Cigna Facility/Professional Professional Modifier Low / Median / High Price $161.60 / $317.70 / $578.88	Professional		$161.60	$317.70	$578.88
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.53 / $72.86 / $141.37	Professional	26	$41.53	$72.86	$141.37
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $127.80 / $246.91 / $430.88	Professional	TC	$127.80	$246.91	$430.88
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $189.84 / $244.89 / $434.40	Professional		$189.84	$244.89	$434.40
Kaiser Permanente Facility/Professional Professional Modifier 26 Low / Median / High Price $52.95 / $69.27 / $112.66	Professional	26	$52.95	$69.27	$112.66
Kaiser Permanente Facility/Professional Professional Modifier TC Low / Median / High Price $136.13 / $175.62 / $342.35	Professional	TC	$136.13	$175.62	$342.35
United Facility/Professional Professional Modifier Low / Median / High Price $160.54 / $272.39 / $506.72	Professional		$160.54	$272.39	$506.72
United Facility/Professional Professional Modifier 26 Low / Median / High Price $31.29 / $60.64 / $106.96	Professional	26	$31.29	$60.64	$106.96
United Facility/Professional Professional Modifier TC Low / Median / High Price $133.68 / $206.69 / $420.12	Professional	TC	$133.68	$206.69	$420.12
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $151.87 / $206.69 / $268.70	Professional		$151.87	$206.69	$268.70
Wellpoint Facility/Professional Professional Modifier 26 Low / Median / High Price $42.96 / $56.33 / $73.23	Professional	26	$42.96	$56.33	$73.23
Wellpoint Facility/Professional Professional Modifier TC Low / Median / High Price $108.91 / $150.36 / $192.21	Professional	TC	$108.91	$150.36	$192.21